Re: "Medical model" in psychiatry/psychotherapy

[Scott Lilienfeld]

My reading of the human literature is that the research evidence for gene-environment interaction (in the sense of a statistical interaction, not gene-environment "transaction," which I suspect most of us now accept as a truism) is still fairly sparse.  In the domain of antisocial behavior/criminality, such interactions have been detected in some, but not all, studies, and Caspi, Moffitt, and colleagues have of course reported widely publicized data for gene-environment interactions for depression (although these important findings await replication).  In other psychopathological domains (e.g., schizophrenia, alcoholism), there is strong evidence for genetic and environmental main effects, but still relatively little for gene-environment interactions (although such interactions are difficult to detect because of statistical power considerations)....Scott Stephen Black wrote: I'll try to reply to to both Sandra's and Allen's queries together here: First Sandra said: "What about the "diasthesis-stress model", in which a psychological or physiological vulnerability interacts with environmental stressors to precipitate symptoms; both psychological (and most likely physiological, although I don't think this model specifies this dimensional outcome)? It seems to me that the preponderance of evidence supports a high degree of interaction of nature-nurture." My description of the true medical model as a procedure which uses symptoms to identify (diagnose) a real underlying structural cause of a disorder doesn't have a problem with this. Presumably the environmental stressors lead to structural changes in the nervous system which can at least potentially be identified (e.g. a decrease in certain neurotransmitters). But if what is proposed is that the stressors lead to symptoms interpreted as causing a change in ego strength, then this would be an application of the quasi-medical model, which seeks not a real cause, but a hypothetical, metaphoric, and imaginary one. In addition, the application of the medical model happily co-exists with the behavioural model, which says that, even in the presence of a particular defect in the nervous system, the form which the particular symptoms take and what can be done about them is responsive to contingencies of reinforcement and other learning variables. For example, Down syndrome is caused by a genetic defect, but outcome can be improved by effective training. In a follow-up post, Sandra then asked: So. . . . is this a medical model?> Psychopharmacology (Berl). 2004 Aug;174(4):463-76. Epub 2004 Apr 16. Human genetics of plasma dopamine beta-hydroxylase activity: applications to research in psychiatry and neurology. Some biochemical and genetic studies suggest associations between low plasma or CSF DbetaH and psychotic symptoms in several psychiatric disorders. Definitely. Then Allen hit me with: (a) In a mental disorder such as schizophrenia there may be (almost certainly are) a number of factors, e.g., genetic propensity, occurrences in the womb before birth, adverse life experiences, regular ingesting of "recreational" drugs in susceptible individuals, and so on. If the working hypothesis is that these factors (genetic propensity, prenatal insult, adverse life experiences, drug adventures) alter the nervous system in ways that are at least potentially identifiable, then we're dealing with a use of the true medical model. If they cause the id to seize control of the personality, not. The point of this terminology isn't really directed at what standard medical investigation does, because that's pretty clear. But psychodynamic theorists have a whole vocabulary (e.g. psychopathology, mental illness, diseased mind, treating patients) and a procedure (observe symptoms and then reach a diagnosis of the underlying cause) which suggests that they're doing the same thing. This leads to confusion. People recognize that medicine has had enormous success in treatment, and if psychotherapists are doing the same thing, then their treatments must be equally respected. But they're not doing the same thing. Doctors search for real causes; psychotherapists search for metaphoric ones. So it's better to describe the procedures of psychotherapists as "quasi-medical"; that is, as imitating and having the superficial appearance of doing what doctors do, without the substance. Stephen ___________________________________________________ Stephen L. Black, Ph.D. tel: (819) 822-9600 ext 2470 Department of Psychology fax: (819) 822-9661 Bishop's University e-mail: [EMAIL PROTECTED] Lennoxville, QC J1M 1Z7 Canada Dept web page at http://www.ubishops.ca/ccc/div/soc/psy TIPS discussion list for psychology teachers at http://faculty.frostburg.edu/psyc/southerly/tips/index.htm _______________________________________________ --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED] -- Scott O. Lilienfeld, Ph.D. Associate Professor Department of Psychology, Room 206 Emory University 532 N. Kilgo Circle Atlanta, Georgia 30322 (404) 727-1125 (phone) (404) 727-0372 (FAX) Home Page: http://www.emory.edu/PSYCH/Faculty/lilienfeld.html The Scientific Review of Mental Health Practice: www.srmhp.org The Master in the Art of Living makes little distinction between his work and his play, his labor and his leisure, his mind and his body, his education and his recreation, his love and his intellectual passions. He hardly knows which is which. He simply pursues his vision of excellence in whatever he does, leaving others to decide whether he is working or playing. To him – he is always doing both. - Zen Buddhist text (slightly modified) --- You are currently subscribed to tips as: archive@jab.org To unsubscribe send a blank email to [EMAIL PROTECTED]